Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Case Reports
. 2025 Apr;15(4):205-209.
doi: 10.13107/jocr.2025.v15.i04.5500.

Intra-Ligamentous Pigmented Villonodular Synovitis of the Anterior Cruciate Ligament, a Case Report

Hesham Mohamed Gawish  1 , Mohamed Abdel Monsef Elghaish  2 , Emam Mohamed Ahmed  2 , Mohamed Abdalla Mahfouz  3 , Waleed Hamed Aziz  4 , Ahmed Hassan Waly  5
Affiliations
Case Reports

Intra-Ligamentous Pigmented Villonodular Synovitis of the Anterior Cruciate Ligament, a Case Report

Hesham Mohamed Gawish et al. J Orthop Case Rep. 2025 Apr.

Abstract

Introduction: Pigmented villonodular synovitis arising from cruciate ligaments is a very rare condition. Arthroscopic management of these lesions is the treatment of choice. Probing of the anterior cruciate ligament (ACL) is very crucial due to the possibility of intraligamentous invasion of this lesion.

Case report: A 40-year-old male patient had anterior knee pain and effusion without giving way. There was no history of trauma before the presentation. In his last attack of locking, he had knee effusion for the 1st time. His magnetic resonance imaging scan revealed partial ACL injury along with intercondylar notch soft-tissue mass, i.e., nodular synovitis. The lesion was seen between the ACL and lateral femoral condyle during arthroscopy. The rest of the lesion was inside the substance of the ACL. After the complete removal of the lesion, ACL reconstruction was done. Microscopic examination revealed a localized pigmented villonodular synovitis.

Conclusion: Specific signs and symptoms for pigmented villonodular synovitis are lacking. Surgeons should have a very high suspicion of intra-articular localization for this type of lesion. Preparation of ligamentous reconstruction is recommended in case of complete ligamentous invasion by the tumor.

Keywords: Pigmented villonodular synovitis; anterior cruciate ligament; arthroscopic synovectomy.

PubMed Disclaimer

Conflict of interest statement

Conflict of Interest: Nil

Figures

Figure 1
Figure 1
Anteroposterior and lateral views of both patient’s knees.
Figure 2
Figure 2
First magnetic resonance imaging sagittal cuts showing intercondylar notch mass related to the anterior cruciate ligament.
Figure 3
Figure 3
The second magnetic resonance imaging showing partial anterior cruciate ligament (ACL) injury along with diffuse thickening of the ACL.
Figure 4
Figure 4
Arthroscopic examination of the patient’s left knee shows the pigmented villonodular synovitis between the patient’s anterior cruciate ligament and the lateral femoral condyle.
Figure 5
Figure 5
The use of basket forceps for removal of the lesion.
Figure 6
Figure 6
The pigmented villonodular synovitis seen inside the anterior cruciate ligament.
Figure 7
Figure 7
After partial removal of anterior cruciate ligament (ACL) fibers, the pigmented villonodular synovitis is seen invading the whole substance of ACL.
Figure 8
Figure 8
The pigmented villonodular synovitis invading the anterior cruciate ligament till its footprint.
Figure 9
Figure 9
After complete excision of the lesion, there was a complete loss of the anterior cruciate ligament.
Figure 10
Figure 10
The new anatomically reconstructed anterior cruciate ligament.
See this image and copyright information in PMC

References

    1. De Ponti A, Sansone V, Malcherè M. Result of arthroscopic treatment of pigmented villonodular synovitis of the knee. Arthroscopy. 2003;19:602–7. - PubMed
    1. Agarwala S, Agrawal P, Moonot P, Sobti A. A rare case of giant cell tumour arising from anterior cruciate ligament:Its diagnosis and management. J Clin Orthop Trauma. 2015;6:140–3. - PMC - PubMed
    1. Dines JS, DeBerardino TM, Wells JL, Dodson CC, Shindle M, DiCarlo EF, et al. Long-term follow-up of surgically treated localized pigmented villonodular synovitis of the knee. Arthroscopy. 2007;23:930–7. - PubMed
    1. Kim SJ, Choi NH, Lee SC. Tenosynovial giant-cell tumor in the knee joint. Arthroscopy. 1995;11:213–5. - PubMed
    1. Otsuka Y, Mizuta H, Nakamura E, Kudo S, Inoue S, Takagi K. Tenosynovial giant-cell tumor arising from the anterior cruciate ligament of the knee. Arthroscopy. 1996;12:496–9. - PubMed

Publication types

LinkOut - more resources